Missed an IVF Injection? What to Do Next

Call your clinic, now, including out of hours. And do not take a double dose to make up for it, whatever seems logical in the moment. Those two things are the whole answer, and everything below is context for them.

Missing a dose feels like a catastrophe you caused. It is worth knowing that clinics field these calls constantly, that one missed injection rarely ends a cycle, and that the outcome depends far more on how quickly you tell them than on the mistake itself.

The panic is not useful. The phone call is.

Why not to fix it yourself

The instinct is to correct the error: take it late, take extra, shift tomorrow's timing to compensate. All of those are worse than the original miss.

Doubling up is the dangerous one. Your dose was calculated for your response and is being adjusted every few days based on monitoring. Two doses at once pushes hormone levels past what the plan assumed, and over-stimulating the ovaries raises the risk of ovarian hyperstimulation syndrome, which is the significant complication of this phase.

Cleveland Clinic's guidance on hCG injection puts it plainly: do not use double or extra doses, and call your care team with questions. The same principle holds across the injectables in a fertility protocol.

There is a second reason to leave it alone. Your clinic is reading your monitoring results against an assumed medication history. If you quietly improvise a correction, the numbers at your next scan get interpreted against a schedule that did not happen, which makes their decisions worse rather than better.

What the clinic will ask you

Having this ready turns a flustered call into a two-minute one. Before you dial, work out:

• Which medication it was, by name. Not "the evening one".
• The dose it should have been, in units.
• What time it was scheduled for, and what the actual time is now.
• Whether it was missed entirely or partially given. A syringe that leaked, or one you stopped halfway, is a different situation from a dose never started.
• Where you are in the cycle, meaning which day of stimulation, and whether you have had a scan recently.
• What else you have taken today, since most protocols run more than one drug.

If you are not certain whether you took it at all, say so rather than guessing. "I genuinely cannot remember" is a common and answerable situation. Presenting a guess as fact is the thing that leads them astray.

The drug matters more than the delay

People fixate on how many hours late they are. The clinic will care more about which medication it was, because the drugs in your protocol do different jobs and tolerate disruption differently.

A stimulation drug that grows follicles behaves differently from a drug whose job is stopping you ovulating early, and both behave differently from progesterone support after a transfer. Missing one of those is not equivalent to missing another, and the right response varies accordingly.

Where you are in the cycle matters too. The same missed drug on day three of stimulation and on day ten of stimulation are not the same event, because your follicles are at different points and the monitoring schedule ahead of you is different.

This is exactly why the answer has to come from someone holding your chart.

The trigger is its own emergency

One exception worth separating out. If the injection you missed or mistimed was the trigger, treat that as more urgent than anything else in this article.

Your retrieval is booked against the trigger time, so a problem there affects a scheduled procedure and a theatre slot, not just a hormone level. Call immediately, at any hour, and say clearly that it was the trigger.

The reasoning behind that timing is covered in more detail in why the trigger shot timing has to be exact. The short version: it starts a clock that the retrieval is aimed into.

The other errors, which get the same answer

Missing a dose is only one of the ways this goes wrong, and the neighbouring mistakes send people searching in a panic too. They resolve the same way.

• Wrong dose. Too little or too much, whether from misreading units or mis-drawing the syringe. Say exactly what went in rather than rounding it to what was intended.
• Wrong drug. More common than you would think when two vials look similar and it is late. Call straight away and name both drugs, the one you took and the one you were meant to.
• Some of it leaked. Fluid running back out of the site, or a syringe you stopped partway. You will not know how much was delivered, and that is fine to report as uncertain.
• Injected in the wrong place. A subcutaneous drug into muscle, or an intramuscular one too shallow. Tell them, since it affects absorption.
• Took it at the wrong time of day. Morning instead of evening, or double the interval by accident.

None of these need a different playbook. Do not attempt a correction, ring the clinic, and give them the actual sequence of events rather than a tidied version.

Being straightforward about it matters more than looking competent. A nurse working from what really happened can help. A nurse working from an edited account cannot.

Why there is no time window here

You will find pages offering thresholds. Within two hours, take it. Beyond four, skip it. We are not going to add another set of numbers to that pile.

Those figures are inconsistent between sources, they are not specific to your drug, and they cannot account for where you are in your protocol. The real risk of publishing one is that a reader lands on a threshold, decides their situation falls inside it, and does not make the call.

The call is the part that helps. A nurse can tell you in a sentence whether to take it now, skip it, or adjust tomorrow, and that sentence is worth more than any article.

After the call

Two small things worth doing once it is resolved.

Write down what happened, with the real times: what was missed, when you noticed, who you spoke to, and what they told you to do. It becomes relevant if your monitoring looks unexpected later, and it saves you reconstructing the week from memory at your next appointment.

Then let it go. Adherence over a whole cycle matters, and one logged and reported miss is a very different thing from a pattern of them. Guilt about it does not improve anything downstream.

Reducing the odds of a next one

Most missed doses are ordinary logistical failures rather than carelessness. Alarms dismissed while half asleep, two people each assuming the other handled it, a schedule that changed midweek and was never updated.

The fixes are unglamorous. One place holding the current schedule rather than a printout that went out of date when your dose changed. A visible daily record, so "did I already do that" is answerable in a glance rather than a memory search. Alarms that require you to actually do something to clear them.

That last one matters more than it sounds. A notification you can swipe away without thinking is not a reminder, it is a habit.

A tracked log is what makes the uncertainty solvable, which is the core of keeping track of IVF medications at all. Marigold holds the current schedule, marks off each dose as done, and keeps the history with real times, which is also what you will be reading back to the clinic on the phone. It records and organises. It does not give medical advice, and only your clinic can tell you what to do about a missed dose.

If you want the log rather than the guesswork, Marigold is free to download on the App Store.